71337 �W (MJF $1 A7JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
JAN 2 5 7
Date........................--1968---.....----------_ 19--------.. Permit No...--1���- ------------
The undersigned hereby makes application to the Plumbing Inspector of the City
of San Jose for a e m't + II id a i nc d/or gas pipes as listed on the
reverse side h ee ga m ices and/or pipes in accordance
with the provisions of rticle V II, hapter 4, of the San Jose Municipal Code, and
other laws applicable thereto.
certify that in the perfor of}A fe v&ate t permit is issued I
shall not employ any person rrrup'6 s(}� ate the workmen's com-
pensation laws of California.
OWNER .... .................................. ---------------------------------------------�
ADDRESS 14�4�1Li------.
USE OF BUILDING ... rQctr fry -L .--------------------------------------
FORM 280-20 4/67 IOM Signed --------MERCURY SHEET METAL & HEATING. INC
1661 Galway Mercury
Type of Appliance No. Remarks (Check
New Replace Relocate
Gas Ranges
. Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces : Q
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Automatic Controls
Flue and/or Vent , G4
Hood and/or Duct
Clothes Dryer
Permit Fee
TOTAL
FEE
Inspected and Approved 528�,Q BY /1
HOUSE GAS PIPING
Number of Outlets Size 'of Main _
FEE
Tested and Approved By